Phase 1 qualitative data collection has been completed in the four selected villages. Periodic review of procedures indicated the need for some small changes in the interview schedules to shorten the length of the focus groups and structured interviews. All data has been compiled, translated, back-translated and is being analyzed by the NIH team using N-Vivo software. Initial findings were presented at the Society of Behavioral Medicine in April 2011. Two manuscripts based on the qualitative data are in preparation. Briefly, results indicated that community members have diverse beliefs about the role of genetics as a cause of podoconiosis. Some individuals believe that genetics is the sole cause of the disease and nothing can be done to prevent it, others see that protective footwear can prevent podoconiosis even among those at genetic risk, and others believe the disease is both genetic and contagious. The next steps will be to develop a prototype intervention that is based in church and neighborhood settings involving role models from the community (e.g., teachers) who will educate about the causes of podoconiosis and encourage consistent footwear. We expect that the prototype intervention will be developed by the team by the end of the 2011. Pilot testing using rapid assessment and evaluation methods will be conducted in early 2012 to assess the feasibility and acceptability of the intervention to promote footwear. Fall 2012 a formal evaluation of the final intervention will be initiated. A second round of pilot activities were completed in March, 2012. These results indicated the feasibility of our genetics education intervention. The community-based intervention trial commenced in January 2013. Six communities have been assigned to one of three intervention conditions: (1) Usual health education about footwear, (2) public health campaign and household-based health education and (3) public health campaign, household based health education that includes information about inherited soil sensitivity. The primary outcome is consistent shoe wearing by an index child who has received shoes from a local NGO. Four survey assessments are conducted: (1) baseline (2) 3 months after the intervention, (3) 10 mos and (4) 15 mos after the intervention. A total of 1800 households have been enrolled, completed the baseline, 3 and 12 month follow-up surveys. The study is now completed and analyses are underway to evaluate trial results. Two manuscripts are nearly completed based on analyses of the baseline surveys. Analyses thus far indicate that affected familiesbeliefs that podoconiosis is inherited are associated with perceptions of decreased value of shoe wearing. Families affected by podoconiosis perceive themselves to be at lower risk for the condition than unaffected families. This may be due to the efforts of a local NGO to educate affected families that podoconiosis is preventable. Unaffected households have not received this education. Additionally, study participants from neighboring households reported having enacted stigma on families affected by the conditions. Similarly, participants affected by the condition reported having experienced stigma. Lastly, reported stigma levels differed significantly across the six communities.